Overview

This trial is active, not recruiting.

Conditions adenocarcinoma of the esophagus, adenocarcinoma of the gastroesophageal junction, adenocarcinoma of the stomach, squamous cell carcinoma of the esophagus, stage ii esophageal cancer, stage ii gastric cancer, stage iii esophageal cancer, stage iii gastric cancer
Treatments erlotinib hydrochloride, oxaliplatin, fluorouracil, radiation therapy, conventional surgery, immunohistochemistry staining method, positron emission tomography, computed tomography, laboratory biomarker analysis, gene expression analysis, fludeoxyglucose f 18
Phase phase 1
Target EGFR
Sponsor Comprehensive Cancer Center of Wake Forest University
Collaborator National Cancer Institute (NCI)
Start date April 2007
End date August 2009
Trial size 64 participants
Trial identifier NCT01561014, CCCWFU 60106, NCI-2009-01447, NCT00499564

Summary

This phase I trial is studying the side effects and best dose of erlotinib hydrochloride when given together with oxaliplatin, fluorouracil, and radiation before surgery and alone after surgery in treating patients with locally advanced cancer of the esophagus and gastroesophageal junction. Drugs used in chemotherapy, such as oxaliplatin and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy together with erlotinib hydrochloride and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving erlotinib hydrochloride after surgery may kill any tumor cells that remain after surgery

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Endpoint classification safety/efficacy study
Intervention model single group assignment
Masking open label
Primary purpose treatment
Arm
(Experimental)
CHEMORADIOTHERAPY: Patients undergo radiation therapy QD, 5 days a week and receive fluorouracil IV continuously and erlotinib hydrochloride PO QD on days 1-38. Patients also receive oxaliplatin IV over 2 hours on days 1, 15, and 29. SURGERY: Within 4-8 weeks after completion of chemoradiotherapy, patients with potentially resectable disease (i.e., complete response, partial response, or stable disease) undergo surgery to remove the tumor. CONSOLIDATION CHEMOTHERAPY: Within 2-4 weeks after surgery, patients with tumors that demonstrate positive immunohistochemistry for EGFR and/or cyclin D1 (in the pretreatment biopsy or in the residual tumor in the esophagectomy specimen) receive consolidation chemotherapy comprising erlotinib hydrochloride PO QD for 12 weeks.
erlotinib hydrochloride CP-358,774
Given PO
oxaliplatin 1-OHP
Given IV
fluorouracil 5-fluorouracil
Given IV
radiation therapy irradiation
Undergo radiotherapy
conventional surgery surgery, conventional
Undergo surgical resection
immunohistochemistry staining method immunohistochemistry
Correlative study
positron emission tomography FDG-PET
Correlative study
computed tomography tomography, computed
Correlative study
laboratory biomarker analysis
Correlative study
gene expression analysis
Correlative study
fludeoxyglucose f 18 18FDG
Undergo F18 PET and CT scan

Primary Outcomes

Measure
Toxicity rate of combination chemotherapy followed by surgery and erlotinib hydrochloride
time frame: Approximately 6 months

Secondary Outcomes

Measure
Time to progression
time frame: Approximately 4 years
Survival
time frame: Approximately 4 years
Specific characteristics that predict complete response rate (e.g., EGFR status, EGFR amplification, and cyclin D1 expression)
time frame: Over 4 years
Specific characteristics that predict complete response rate (e.g., EGFR status, EGFR amplification, and cyclin D1 expression)
time frame: Approximately 1 year
Test the predictive value of FDG-PET-CT imaging in identifying patients who will have a complete response
time frame: Approximately 1 year

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria: - Newly diagnosed patients with locally advanced esophageal cancer with either squamous or adenocarcinoma histology; patients should have evidence of extension of disease into or through the wall of the esophagus (T2-4) and/or regional nodal metastasis (N1) - Eastern Cooperative Oncology Group (ECOG) performance status 0-2 - Non-pregnant; patients of childbearing potential and their partners must agree to use an effective form of contraception during the study and for 90 days following the last dose of study medication (an effective form of contraception is an oral contraceptive or a double barrier method); nursing mothers are also ineligible - Prior treatment: Greater than one week shall have elapsed since any major surgery; no prior chemotherapy or radiotherapy is allowed - Adequate whole blood cell (WBC) and platelets (Plt) as determined by medical oncology - Serum creatinine =< 1.5 mg/dl - Creatinine clearance >= 60 ml/min - Hemoglobin (Hgb) >= 9.0 gm/dl - Absolute neutrophil count >= 1,500/uL - Serum total bilirubin =< 1.5 mg/dL - Alkaline phosphatase =< 3X the upper limit of normal (ULN) for the reference lab - Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than 2X ULN for the reference laboratory - Patients must be told of the investigational nature of the study and must sign a written informed consent - No serious medical or psychiatric illnesses which would prevent informed consent or otherwise limit survival to less than two years; no history of refractory congestive heart failure or cardiomyopathy - Patients should be evaluated by medical oncology, radiation oncology, and surgery, and felt to by all to be suitable for trimodality therapy Exclusion Criteria: Patients with an active infection or with a fever >= 38.5 degrees Celsius (C) within 3 days of the first scheduled day of protocol treatment - History of prior malignancy within the past 5 years except for curatively treated basal cell carcinoma of the skin, cervical intra-epithelial neoplasia, or localized prostate cancer with a current prostate surface antigen (PSA) of < 1.0 mg/dL on 2 successive evaluations, at least 3 months apart, with the most recent evaluation no more than 4 weeks prior to entry - Patients with known hypersensitivity to any of the components of oxaliplatin - Patients who are receiving concurrent investigational therapy or who have received investigational therapy within 30 days of the first scheduled day of protocol treatment (investigational therapy is defined as treatment for which there is currently no regulatory authority approved indication) - Peripheral neuropathy >= Grade 2 - History of allogeneic transplant - Known human immunodeficiency virus (HIV) or Hepatitis B or C (active, previously treated or both) - Pregnancy

Additional Information

Official title A Phase I Study of Preoperative Chemoradiation With Oxaliplatin, 5-Fluorouracil, Erlotinib and Radiation Followed by Resection and Consolidative Erlotinib for Patients With Locally Advanced Cancer of the Esophagus and Gastroesophageal Junction
Principal investigator Arthur Blackstock
Description OBJECTIVES: I. The primary aim of this phase I study is to evaluate the safety of multi-drug chemotherapy (with the addition of an anti-epidermal growth factor receptor [EGFR] agent erlotinib [erlotinib hydrochloride]) and concomitant radiotherapy followed by resection and consolidative erlotinib for the treatment of locally advanced esophageal cancer as judged by the dose limiting toxicities. Correlative endpoints include an analysis of pre-treatment tumor cyclin D1 expression and EGFR expression/amplification. III. Correlate pathologic complete response with changes in fludeoxyglucose F 18 (FDG)-positron emission tomography (PET)-computed tomography (CT) - pre and post-chemoradiation. OUTLINE: This is a dose escalation study of erlotinib hydrochloride CHEMORADIOTHERAPY: Patients undergo radiation therapy once daily (QD), 5 days a week and receive fluorouracil intravenously (IV) continuously and erlotinib hydrochloride orally (PO) QD on days 1-38. Patients also receive oxaliplatin IV over 2 hours on days 1, 15, and 29. SURGERY: Within 4-8 weeks after completion of chemoradiotherapy, patients with potentially resectable disease (i.e., complete response, partial response, or stable disease) undergo surgery to remove the tumor. CONSOLIDATION CHEMOTHERAPY: Within 2-4 weeks after surgery, patients with tumors that demonstrate positive immunohistochemistry for EGFR and/or cyclin D1 (in the pretreatment biopsy or in the residual tumor in the esophagectomy specimen) receive consolidation chemotherapy comprising erlotinib hydrochloride PO QD for 12 weeks. After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually thereafter.
Trial information was received from ClinicalTrials.gov and was last updated in July 2015.
Information provided to ClinicalTrials.gov by Comprehensive Cancer Center of Wake Forest University.